Provider Demographics
NPI:1043492812
Name:LANDRETH, JESSICA ROSE (MS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSE
Last Name:LANDRETH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ROSE
Other - Last Name:SAPPENFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1275 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5016
Mailing Address - Country:US
Mailing Address - Phone:805-234-6261
Mailing Address - Fax:
Practice Address - Street 1:1275 HIGH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5016
Practice Address - Country:US
Practice Address - Phone:805-234-6261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA56708101YP2500X, 106H00000X
CA51669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist